Antidepressants Printed
Antidepressants Printed
Antidepressants Printed
H31/1887/2000
INTRODUCTION
Antidepressant drugs do not cure depression, they only alleviate symptoms and are often
used over the course of a lifetime to prevent recurrence of symptoms. Although both
brain abnormalities and circadian rhythms have been implicated as factors in depression,
the predominant theory states that depression is caused by insufficient activity of
monaminergic neurons within the brain, this belief is called the Biological Amine Theory
of Depression or the MonoAmine Hypothesis. It attempts to explain clinical depression in
terms of a chemical imbalance within the brain, the specific areas or structures involved
are still unknown.
The goals of antidepressant therapy, for major depression and dysthymia, are short-term
effectiveness in controlling acute episodes of major depression and the prevention of their
reoccurrence.
CLASSIFICATION
3. HETEROCYCLICS
Also called atypical antidepressants. They are subclassified as follows:
i) Second-Generation Antidepressants- e.g amoxapine, maprotiline, trazodone,
bupropion
ii) Third Generation Antidepressants- e.g. mirtazapine, venlafaxine, nefazodone
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faster onset of action, along with less severe side effect profiles. Often the decision on
which agent to prescribe is based upon what side effects a client can best tolerate.
CLINICAL INDICATIONS
1. Mood disorders:
i. Unipolar Major Depression
ii. Dysthymia
iii. Bipolar Mood Disorders
2. Anxiety disorders:
i. Panic disorder- imipramine has been shown to be as effective as MAO inhibitors
and benzodiazepines in management of Panic disorder. Though benzodiazepines
exert a more rapid onset of action than SSRIs, they are associated with
physiologic dependence. SSRIs may be used in this case though they require
several weeks to produce full therapeutic effect.
ii. Obsessive Compulsive Disorders (OCDs)- SSRIs such as fluoxetine and
fluvoxamine are uniquely effective for treatment of OCDs. However,
clomipramine may be more potent than SSRIs.
iii. Post-Traumatic Stress Syndrome (PTSD)
iv. Phobias –treated with SSRIs
v. Generalized anxiety disorder –treated with combined norepinephrine and
serotonin reuptake inhibitiors
3. Other indications include
i. Enuresis –TCAs are used but are not the recommended approach because the
beneficial effect only lasts as long as the treatment is continued.
ii. Chronic pain- TCAs may be used alone or in combination with phenothiazines.
iii. Eating disorders e.g. bulimia (treated with fluoxetine)
iv. Attention Deficit Disorder ( treated with TCAs such as imipramine and
desipramine)
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Weight gain
Urinary retention
Diarrhoea
Seizures
Impairment of psychomotor function and tremors
Skin rashes
Sedation
Induction of psychosis de novo
Cardiac depression and increased electrical irritability within the heart causing
arrhythmias, both of these conditions may be fatal.